Tag: Opioid

A new study found that 47% of injured workers with chronic opioid use weaned off the painkillers completely within 24 months and that those who did not wean reduced their opioid dosage by an average of 52%, the Workers Compensation Insurance Rating Bureau of California announced Thursday.
The Oakland, California-based ratings agency studied its databases of medical transaction records and unit statistical reports since July 2012 to examine the cost implications of chronic opioid use and the process of weaning injured workers off opioids statewide.
The study also found that claims involving chronic opioid use cost more than nine times in physician services than the average workers comp claim and that the median time from chronic opioid use to weaning completely was eight months.
Meanwhile, the median time from accident date to when the worker was weaned off completely was 19 months.
The study also examined types of injuries treated, finding that “over 80% of transactions associated with chronic opioid claimants had primary diagnoses of soft tissue injuries.
Injured workers who weaned off were more likely to have Nature of Injury codes for Fractures, and less likely to have Unspecified Injuries than those who did not wean off.”

Longer-term prescribing of opioids more than triples the duration of temporary disability among workers with work-related, nonsurgical, lower-back injuries when compared to claims with no opioid prescribing, according to a study released Thursday by the Cambridge, Massachusetts-based Workers Compensation Research Institute.
Using data from 28 states, for injuries between 2008 and 2013 where workers had more than seven days of lost work time, the study estimated the effects of opioid prescriptions measured in several ways, including whether workers received multiple prescriptions for opioids and whether workers had opioid prescriptions within the first three months after an injury and three or more filled opioid prescriptions between the 7th and 12th months after an injury.
Researchers culled information on opioid prescriptions from prescription transaction data collected from workers compensation insurers and their medical bill review and pharmacy benefit management vendors, according to the study.
The study also found that local prescribing patterns played a strong role in determining whether injured workers receive opioid prescriptions.
Workers who lived in high-prescription states, per pharmacy data, were more likely to receive opioid prescriptions than workers who lived in low-prescription areas.
“Our results imply that a 10-percentage-point increase in the local rate of longer-term opioid prescribing is associated with a 2.6-percentage-point higher likelihood that an otherwise similar injured worker would receive longer-term opioid prescriptions,” the study states.

Going from a three-month prescription to month-to-month will be a burden, but it’s also not required by the proposed regulations by the Mississippi State Board of Medical Licensure.
What the board is requiring in its proposed regulations, which are still being considered and won’t take effect for months, is for doctors to rethink the way they prescribe opioids, even for chronic pain.
It also stressed patient education — that patients should know not only the risks of opioid use, but also the limited evidence that opioids actual work for long-term pain management.
Any patient prescribed opioids for chronic pain will be required to take a drug test three times a year.
While the average meal in Scott County costs 10 percent more than the maximum benefits from the Supplemental Nutrition Assistance Program, the average meal in Lafayette County costs 53 percent more.
SPEAKING OF TOBACCO, the director of the Centers for Disease Control and Prevention, Brenda Fitzgerald, resigned Wednesday after Politco reported she had bought shares in a tobacco company.
THERE ARE OVER 200 MEDICATIONS in the works to treat and prevent heart disease, according to a report released from PhRMA Thursday.
They run a nonprofit health insurance company that contracts with Medicaid in California, according to Kaiser Health News.
Mississippi’s own managed care contract has received scrutiny, with some lawmakers wondering who could be profiting from dollars intended to provide citizens with health care.
While extraordinary, the bill illustrates the potential for exploitation of a proposed regulation in Mississippi requiring drug tests before doctors can prescribe opioids and benzodiazepines.

TIME Health For more, visit TIME Health.
Two very different treatments.Sarah Sherbert’s first child was whisked away to a hospital special-care nursery for two weeks of treatment for withdrawal from doctor-prescribed methadone that her mother continued to use during her pregnancy.
His hospital stay was just a week.
Once the umbilical cord is cut, babies born to opioid users are at risk for developing withdrawal symptoms.
Symptoms can last for months.
Some studies have suggested possible increased risks for developmental delays and behavior problems, but no research has been able to determine if that’s due to mothers’ drug use during pregnancy, infants’ treatment after birth or something completely unrelated.
A recently published Dartmouth-Hitchcock Medical Center analysis linked rooming-in with less medication use and shorter hospital stays for infants, but it can be difficult if mothers are still in the throes of addiction.
At Greenville Memorial Hospital, where Sarah Sherbert’s son was delivered two years ago, babies born to methadone users are given that drug before symptoms start and are sent home with a supply to continue treatment.
Clemson University research has showed that approach could reduce hospital stays by nearly half, to an average of eight days costing $11,000 compared with the state average of 15 days at a cost of $45,000.
She was on methadone prescribed by her doctor when her daughter, now 3, was born.

(CHERRY HILL, N.J.) — Less than three months after President Donald Trump declared the U.S. opioid crisis a public health emergency, the nation’s governors are calling on his administration and Congress to provide more money and coordination for the fight against the drugs, which are killing more than 90 Americans a day.
The list of more than two dozen recommendations made Thursday by the National Governors Association is the first coordinated, bipartisan response from the nation’s governors since Trump’s October declaration.
The governors praised him for taking a first step, which included a pledge to support states’ efforts to pay for drug treatment through Medicaid, the joint federal-state health insurance program for low-income people.
But the governors also called for more action.
Trump’s emergency declaration came in response to recommendations from a commission he appointed to address the toll of opioids, a class of drugs that ranges from prescription painkillers to illegal drugs such as heroin and illicit fentanyl.
It was chaired by former New Jersey Gov.
Chris Christie, a Republican who left office this week.
“The opioid and heroin epidemic knows no boundaries, and governors across the country are keenly aware of the challenges it poses for our communities and the growing need for comprehensive, bipartisan solutions to help end the epidemic,” Massachusetts Gov.
A spokesman for the White House Office on National Drug Control Policy said the administration is committed to working with states and addressing their recommendations.
The governors also called for the White House to put someone in charge of a coordinated effort on opioids.

Most people agree that the federal government should tackle public health crises, and there is a particular consensus about the current epidemic involving opioids.
The White House announced last fall that President Trump was “mobilizing his entire administration to address drug addiction and opioid abuse by directing the declaration of a nationwide public health emergency to address the opioids crisis.” Yet as of today, there is no permanent head of the Drug Enforcement Administration.
The Food and Drug Administration, in approving new opioid drugs, puts more opioids in the marketplace because these drugs meet the standards for safety and efficacy in treating certain forms of pain.
White House czars are largely ineffective because they do not control the agency heads who are legally responsible for carrying out the various congressional mandates of the czars.
There is a world of difference between someone whose authority is to coordinate and someone who has the true authority to impose change.
Moreover, the president’s drug control policy office has been more heavily focused on law enforcement than on public health strategies.
The task of educating physicians and health professionals about opioids has been spread across multiple agencies: the Centers for Disease Control and Prevention, which established primary physician practice guidelines; the National Institute of Drug Abuse; the Substance Abuse and Mental Health Administration; the Food and Drug Administration; and the Office of the Surgeon General.
But this requires central leadership.
The administration needs to put under one authority all of the programs and funding sources focused on drug abuse now spread among more than a dozen agencies.
These include the D.E.A., the F.D.A.’s addiction and review and enforcement activities, the National Institute of Drug Abuse, the Substance Abuse Mental Health Administration and those portions of the Centers for Medicare and Medicaid Services that fund addiction treatment centers.

But Robert Cessar, a longtime federal prosecutor, was unaware of Zielke until Justice Department officials handed him a binder of data that, he said, confirmed what pill-seekers from as far away as Ohio and Virginia already knew.
His indictment in October was the first by a nationwide group of federal law enforcement officials that, armed with new access to a broader array of prescription drug databases, Medicaid and Medicare figures, coroners’ records and other numbers compiled by the Justice Department, aims to stop fraudulent doctors faster than before.
The department is providing a trove of data to the Opioid Fraud and Abuse Detection Unit, which draws together authorities in 12 regions across the country, that shows which doctors are prescribing the most, how far patients will travel to see them and whether any have died within 60 days of receiving one of their prescriptions, among other information.
The president called it a public health emergency, a declaration that allows the government to redirect resources in various ways to fight opioid abuse.
While the effectiveness of the Trump administration’s broader strategy remains to be seen, the Justice Department’s data-driven effort is one small area where federal prosecutors say they can have an impact.
Investigators can also get a sense for where displaced patients will turn next.
Authorities acknowledge there are legitimate reasons for some doctors to prescribe large quantities of opioids, and high prescribing alone doesn’t necessarily trigger extra scrutiny.
The effort operates on the long-held perception that drug addiction often starts with prescriptions from doctors and leads to abuse of more dangerous black market drugs like fentanyl, which, for the first time last year, contributed to more overdose deaths than any other legal or illegal drug, surpassing pain pills and heroin.
Those patients will turn to harder street drugs or even kill themselves, he said.
Instead of more prosecutions, he said, the government “should promote more alternative therapies,” he said.

Reprints Louise Esola Researchers in California were the first to find that most Medicare set-aside settlements in the state include money for opioids, but experts say the problem is a national issue, taking injured workers on opioids out of the comp system and onto a lifetime guarantee of paid opioids.
“I start to think we are making progress and we are getting somewhere and opioid use in comp is down, and then you come across something like this,” said Alex Swedlow, president of the Oakland-based California Workers’ Compensation Institute, which conducted a study that found 70% of federally mandated and approved California workers compensation Medicare set-aside settlements for injured workers include money earmarked for decades of opioid use.
“We have no reason to believe this problem is any different in any other state,” said co-researcher David Deitz, a physician and managed care consultant who runs his own consulting firm David Deitz & Associates L.L.C.
based in Westport, Massachusetts.
Medicare set-asides are insurer-paid plans in which claims administrators allocate funds from workers comp settlements to cover future medical expenses arising from a work injury that might otherwise be paid by the federal Medicare program.
“It’s a confirmation of what we believe has existed,” said Rita Wilson, CEO and co-founder of Delray Beach, Florida-based Tower MSA Partners L.L.C., which helps insurers and employers remain Medicare-compliant and began tackling the opioids in Medicare set-asides in mid-2015.
This is unlike the typical workers comp scenario, where injured workers can rely on nurse case managers, pharmacy benefits managers, insurers, self-insured employers and others to guide the injured workers off the dangerous doses — a trend in comp spurred by regulations and treatment guidelines that now say chronic pain is not relieved by powerful pain medications.
Medicare set-asides, and the prescriptions they guarantee, are the responsibility of the injured workers and their treating physicians, said Michael Merlino, a Buffalo, New York-based attorney and senior vice president for Medicare compliance for Sedgwick Claims Management Services Inc.
In a statement provided to Business Insurance, the U.S. Centers for Medicare and Medicaid Services officials say the money it approves for the set-aside is part of a formula.
“CMS is approving (Medicare set-asides) with decades of opioid use … I think that has people concerned,” said Mr. Merlino.

Researchers in California were the first to quantify how many Medicare set-asides had money earmarked for opioids — 70% of closed workers compensation claims in California include cash for future pain prescriptions, they found — but experts say the problem is a national issue.
“It’s extremely frustrating.” The institute released its analysis on Oct. 30, finding that most federally mandated and approved California workers compensation Medicare set-aside settlements for injured workers require funding for decades of opioid use.
“This was the data sample we had access to; we have no reason to believe this problem is any different in any other state,” said co-researcher Dr. David Deitz, a managed care consultant who runs his own firm, David Deitz & Associates L.L.C., out of Westport, Massachusetts.
“California is not unique in this respect.” Medicare set-asides are insurer-paid plans in which claims administrators allocate funds from workers comp settlements to cover future medical expenses arising from a work injury that might otherwise be paid by the federal Medicare program.
The study also examined drug strength, using data on morphine milligram equivalents in approved Medicare set-aside plans to find that the comp-based plans are 45 times the cumulative morphine milligram equivalents — a standard for measuring opioid drug strength — that were used from the date of injury to claim closure in a control group of permanent disability claims with similar injuries.
“It’s a confirmation of what we believe has existed,” said Rita Wilson, CEO and co-founder of Delray Beach, Florida-based Tower MSA Partners L.L.C., which helps insurers and employers remain Medicare-compliant and began tackling the opioids in the Medicare set-asides scheme in mid-2015.
The problem, as some see it, is that the federal program allows comp claims to close with cash set aside to pay for future drugs — often strong doses — with little oversight.
This is unlike the typical workers comp scenario, where injured workers can rely on nurse case managers, pharmacy benefits managers, insurers, self-insured employers and others to guide the injured workers off the dangerous doses — a trend in comp spurred by regulations and treatment guidelines that now say chronic pain is not relieved by powerful pain medications.
Mr. Merlino added that the numbers discovered in California raised eyebrows: “CMS is approving (Medicare set-asides) with decades of opioid use … I think that has people concerned.” Officials with the Baltimore-based CMS could not be reached for comment, although the office on Nov. 1 announced its plans to provide more treatment options for recipients who are addicted to opioids.
Joe Paduda, a managed care expert and president of Skaneateles, New York-based CompPharma L.L.C., is calling for change in the Medicare set-asides approval process, saying more oversight is necessary.

Reprints Louise Esola An analysis on opioid prescribing and workers compensation shows that nearly 70% of federally mandated and approved California workers compensation Medicare set-aside settlements for injured workers require funding for decades of opioid use.
The study released Monday by the California Workers’ Compensation Institute also found the prescriptions were often at dangerously high levels and in conjunction with other high-risk drugs.
Medicare set-asides are insurer-paid plans in which claims administrators allocate funds from workers comp settlements to cover future medical expenses arising from a work injury that might otherwise be paid by the federal Medicare program.
The Oakland, California-based research nonprofit found that opioids are the most commonly prescribed drug for set-asides, accounting for 28% of all prescription drugs and 33% of all prescription drug allocations, which the institute says represents “significantly higher proportions than in the general workers comp population.” The study also examined drug strength, using data on morphine milligram equivalents in approved Medicare set-aside plans to find that the comp-based plans are 45 times the cumulative morphine milligram equivalents — a standard for measuring opioid drug strength — that were used from the date of injury to claim closure in a control group of permanent disability claims with similar injuries.
For set-aside settlements with opioids, injured workers were on average approved for a daily dose of 54.7 morphine milligram equivalents for an average of 20.9 years, with over 10% of set-aside plans with opioids having an estimated morphine equivalent dose level of over 90 morphine milligram equivalents per day, a marker of elevated risk to the patient, the study states.
Additionally, 14.5% of plans with opioids had concurrent prescription reserves for sedative-hypnotics, while 4.8% of plans with opioids included sedative-hypnotics mostly used for sleep disorders and muscle relaxant prescriptions, the study found.
To gather information, the authors of the study compiled a sample dataset of California set-aside cases from four national vendors that represent more than half of the state’s market for Medicare set-asides.
The final sample dataset consisted of 7,926 cases completed, submitted and approved between January 2015 and December 2016.

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